Elimination and eradication goals for communicable diseases: a systematic review

Abstract Objective To consolidate recent information on elimination and eradication goals for infectious diseases and clarify the definitions and associated terminology for different goals. Methods We conducted a systematic search of the World Health Organization’s Institutional Repository for Information Sharing (WHO IRIS) and a customized systematic Google advanced search for documents published between 2008 and 2022 on elimination or eradication strategies for infectious conditions authored by WHO or other leading health organizations. We extracted information on names of infectious conditions, the elimination and eradication goals and timelines, definitions of goals, non-standardized terminology, targets and assessment processes. Findings We identified nine goals for 27 infectious conditions, ranging from disease control to eradication. In comparison with the hierarchy of disease control, as defined at the Dahlem Workshop in 1997, six goals related to disease control with varying levels of advancement, two related to elimination and one to eradication. Goals progressed along a disease-control continuum, such as end of disease epidemic to pre-elimination to elimination as a public health problem or threat. We identified the use of non-standardized terminology with certain goals, including virtual elimination, elimination of disease epidemics, public health threat and public health concern. Conclusion As we approach the 2030 target date to achieve many of the goals related to disease control and for other infections to become candidates for elimination in the future, clarity of definitions and objectives is important for public health professionals and policy-makers to avoid misperceptions and miscommunication.


Introduction
In the past two decades, strong political and financial commitments have led to remarkable national and regional achievements in controlling communicable diseases.The World Health Organization (WHO) has called the final decade of the sustainable development goals (SDGs) a decade for disease elimination. 1 To meet the 2030 targets of ending long-term epidemics of infectious diseases, such as human immunodeficiency virus (HIV), tuberculosis, viral hepatitis and neglected tropical diseases, requires an integrated response.It is important that these initiatives are developed and clearly communicated using standardized terminology.
WHO leads the intergovernmental community in tackling global health challenges, and takes direction on setting priorities from its 194 Member States, and other technical and financial partners.The World Health Assembly, the decisionmaking body of WHO, which is attended by delegations from the Member States, passes resolutions with specific health objectives, including those on disease control, elimination and eradication. 2,3The first and only human communicable disease targeted for eradication for which this goal has been achieved is smallpox, in 1977. 4Some eradication programmes have been unsuccessful, such as for malaria, hookworm and yellow fever. 5Nonetheless, these setbacks have contributed to our understanding of the complexities of disease eradication.Subsequently, the World Health Assembly called for other goals, such as the elimination of certain infectious diseases as a public health problem.With the increasing number of disease-control goals, one of the aims of the Dahlem Workshop in 1997 was to outline the hierarchy of definitions of disease control (Box 1) 3 These definitions have been embedded in the strategic recommendations of WHO.
Elimination of any infectious disease is an ambitious strategy requiring substantial resources to succeed.Often, as the occurrence of an infection falls, further resources are needed to reach the most marginalized or vulnerable subgroups.A perception that a disease has been eliminated, when in fact it has just declined and transmission is still occurring locally, could have serious unintended consequences.For example, commitment and funding from donors may fall or preventive attitudes and behaviours in the community may change, leading to re-emergence of the disease.This danger is illustrated by the resurgence of tuberculosis in affluent countries in the 1990s due to overly confident predictions that led to decreased public health expenditure. 6,7More recently, the goal of ending the acquired immunodeficiency syndrome (AIDS) epidemic has been formulated differently in different country strategies.For example, Australia aims to "virtually eliminate" HIV or "end HIV transmission" by 2025, 8,9 and England aspires to end or eliminate or eradicate HIV transmission by 2030. 10,11It is unclear if the end goal of these strategies is ending the AIDS epidemic or if they have more optimistic targets, and if the terms such as virtual elimination, interruption of transmission and elimination of transmission can be used interchangeably.Consistency in terminology and definitions is crucial to reduce misperceptions and ensure uniformity of appropriate goals and outcomes.
Previous reviews described the inconsistencies in the language around disease control initiatives. 12However, they did not systematically examine the terminology used for all infections and infectious diseases (hereafter called infectious Bull World Health Organ 2023;101:649-665| doi: http://dx.doi.org/10.2471/BLT.23.289676   Infectious diseases control goals Laila Khawar et al. conditions) targeted for elimination or eradication.In this systematic review we aim to: (i) describe the elimination and eradication goals set by WHO in relation to their definitions in Box 1; (ii) identify inconsistent terminology to facilitate the use of a standardized approach in developing and communicating these initiatives; and (iii) bring together in one place the most recent information on elimination and eradication goals and timelines, their associated targets, and assessment processes (formal processes to document the achievement of a goal in a country or region, led by WHO) for the infectious conditions targeted by these goals.

Methods
We conducted this review and report its findings according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting standards. 13The study is registered in PROSPERO (CRD42018099733).

Search strategies
We searched WHO's Institutional Repository for Information Sharing for documents that were authored or coauthored by WHO, published between 2008 and 2022, in any language, and with titles containing: "elimination" OR "eliminating" OR "eliminate" AND/ OR "eradication" OR "eradicating" OR "eradicate".In addition, we conducted a Google Advanced Search using the same terms (not restricted to titles only), limited to the WHO domain (http:// www .who.int)and in the six official WHO languages -Arabic, Chinese, English, French, Russian and Spanish.We used these two cluster terms separately for elimination and eradication documents to make sure that we included documents with either or both terms.We then combined the searches.We conducted the searches on 2 and 3 August 2022 for elimination and eradication, respectively.
We also contacted WHO headquarters to identify other documents for possible inclusion.Lastly, we checked reference lists of the fully reviewed records to identify publications on the infectious conditions whose latest strategies were published before 2008, and documents that contained universally accepted targets for an infection but were authored by other organizations, for example, the Joint United Nations Programme on HIV/ AIDS (UNAIDS).We did not put any restrictions on publication date for documents retrieved through the last two strategies.We did not search bibliographic databases such as PubMed® and Embase® because goals related to infectious disease elimination and eradication are defined by WHO and its partner organizations, and the relevant documents are published on these organizations' websites rather than in peer-reviewed journal articles.

Eligibility criteria
Inclusion criteria were: documents that comprehensively described elimination or eradication strategies, including goals, timelines, targets and assessment processes for infectious conditions at the global level or at a specific geographical level, such as the WHO regions.
Exclusion criteria were: (i) documents on non-infectious conditions; (ii) documents on infectious conditions that were educational or media material, older progress reports (global and/or regional) and technical documents on treatment, vaccines and survey methods; (iii) country-specific reports -except for neglected tropical diseases where the infection is predominantly confined to that country; and (iv) documents on infectious conditions targeted for global disease control only.
Where more than one report described the goals, targets or assessment processes, we only included the most recent document.Where two or more reports described non-overlapping components (for example, goals versus assessment process, or a strategical transition from one goal to another), we included all documents.

Search and review process
Two researchers searched for documents and screened titles, table of contents and foreword for elimination and eradication.The researchers then independently screened full-text documents to assess eligibility (Fig. 1 and Fig. 2).Disagreements were discussed with a third researcher and resolved by consensus.

Data extraction and analysis
A standardized data extraction tool captured information on the variables of interest.We stored the extracted data in an Excel file (Microsoft, Redmond, United States of America).
We extracted data on the following variables: (i) infection type and name of the infectious condition; (ii) goals and timelines to achieve the goals; (iii) definitions of the goals; (iv) assessment process; (v) epidemiological endpoints and their impact targets -measures such as prevalence or incidence that are used to measure the impact of an intervention; (vi) interventions and their process targets -interventions being the public health responses to address the disease of interest, and process targets being the benchmarks to be achieved for these interventions; and (vii) other, such as the geographical focus of the goal, achievement of goal, and the different case definitions important to understand the goals, for example, imported versus endemic cases.

Disease control
Reduction of disease incidence, prevalence, morbidity and/or mortality to a locally acceptable level as a result of deliberate efforts.Continued actions are required to maintain the decrease.

Elimination of disease
Reduction to zero of the incidence of a specified disease in a defined geographical areas as a result of deliberate efforts.Continued actions are required to prevent re-establishment.Example: neonatal tetanus

Elimination of infection
Reduction to zero of the incidence of infection caused by a specific agent in a defined geographical areas as a result of deliberate efforts.

Results
The search strategies retrieved 219 documents on eradication and 429 on elimination.Of these documents, we selected 36 on eradication and 127 on elimination for full text review.After review of the references, we included an additional five documents on elimination.After full text review, we included 11 eradication and 46 elimination documents in the review.Two documents included information on both eradication and elimination and were included in both categories; therefore, 55 documents met the relevant eligibility criteria (Fig. 1; Fig. 2 and Table 1).

Types of goals
We identified eight goals related to some form of elimination or eradication (Table 2).These goals were defined for 27 infectious conditions (available in the online repository). 69A goal of disease control was also defined for three infectious conditions, giving a total of nine goals.The goal categories were not mutually exclusive across infectious conditions -11 conditions had more than one goal (Chagas disease, cholera, human African trypanosomiasis (gambiense), human immunodeficiency virus (HIV), leishmaniasis, leprosy, rabies, schistosomiasis, syphilis, tuberculosis and viral hepatitis B; Table 2).Only smallpox had met the goal of worldwide permanent reduction to zero and was certified as eradicated in 1980.Leprosy alone had met the global goal of elimination as a public health problem (in 2000), and human African trypanosomiasis (gambiense) had partially met that goal (in 2020).

Definitions
The documents related to the goals of worldwide permanent reduction to zero, and interruption of transmission or endemic transmission, had definitions of goals that matched their respective definitions of eradication and elimination of disease or infection shown in Box 1. Elimination as a public health problem, a goal related to both infection and disease, was defined in eight documents reviewed as achievement of the measurable targets set by WHO, which when reached required continued action to maintain the targets. 22,36,44,47,55,56,62,63All documents with goals for elimination as a public health problem had measurable impact targets for specific diseases that

Polio
Elimination documents WHO 25 2011 Lymphatic filariasis WHO 26 2011 Schistosomiasis WHO 16 2012 Neglected tropical diseases WHO 27 2014 Tuberculosis WHO Regional Office for Europe 28 2014 Measles and rubella WHO 29 2015 Malaria WHO 30 2015 Tuberculosis WHO 31 2015 Tuberculosis WHO 32 2016 Human onchocerciasis WHO 33 2016 Trachoma WHO Regional Office for South-East Asia 34

2016
Kala-azar WHO 35 2017 Cholera WHO 36 2017 Lymphatic filariasis WHO Regional Office for the Western Pacific 37

2017
Measles, rubella and congenital rubella syndrome Pan American Health Organization; WHO Regional Office for the Americas 38

2017
Measles, rubella and congenital rubella syndrome Pan American Health Organization; WHO Regional Office for the Americas 39 2017 Mother-to-child transmission of HIV, syphilis, hepatitis B and Chagas disease WHO, FAO and World Organization for Animal Health 40 2018 Rabies WHO 41 2018 Rabies WHO, UNICEF, Gavi 42 2018 Yellow fever epidemics WHO Regional Office for the Western Pacific 43 2018 Mother-to-child transmission of HIV, hepatitis B and syphilis WHO 44 2019 Tetanus WHO Regional Office for South-East Asia 45

2019
Measles,rubella and congenital rubella syndrome WHO 46 2019 Soil-transmitted helminthiases WHO 47 2020 Cervical cancer WHO 22 2020 Neglected tropical diseases WHO 48 2020 Leprosy WHO 49 2020 Malaria WHO 50 2020 Measles, rubella and congenital rubella syndrome coincided with the definition of the goal, and matched the definition of disease control shown in Box 1.One document defined the goal of elimination as a public health threat as equivalent to the goal of elimination as a public health problem. 63The documents with goals of pre-elimination and end of disease epidemic had measurable impact targets for different levels of reduction in disease prevalence, incidence, morbidity or mortality.These targets coincided with the definition of disease control in Box 1.For the goal of end of disease epidemic, most conditions had percentage reduction thresholds for impact targets defined at a global level, with countries being encouraged to develop appropriate targets for the local context.In comparison, for different subclassifications of a public health-related goal (elimination as a public health problem or threat, elimination of vertical transmission and pre-elimination), all conditions had impact targets based on case numbers, rates or prevalence percentage defined at a national or subnational level (Table 3).
The sequential nature of the goals for cholera, human African trypanosomiasis (gambiense), leprosy, rabies, schistosomiasis and tuberculosis, and their varying thresholds, indicated the progression of goals on the diseasecontrol spectrum (Table 2 and Table 3).For instance, tuberculosis goals ranged from ending the epidemic in highincidence countries (defined as 90% reduction in incidence, equivalent to 10 cases per 100 000 population by 2035); to pre-elimination in low-incidence countries (defined as 90% reduction in incidence, equivalent to < 10 cases per 1 000 000 population by 2035); and elimination as a public health problem in low-incidence countries (defined as < 1 case per 1 000 000 population by 2050; Table 3).See online repository for quantitative impact targets. 69

Non-standardized terms
Some non-standardized terms were used to describe certain goals.These terms included: (i) virtual elimination for vertical transmission of HIV as a public health problem at < 2% and < 5% transmission rate in breastfeeding and non-breastfeeding countries, respectively; 62 (ii) public health threat for cholera, meningitis A, HIV and viral hepatitis B and hepatitis C; 35,61,63,64 and (iii) public health concern for bacterial sexually transmitted infections. 64tandardized definitions for a condition deemed to be a threat or concern were not provided.Some potentially misleading terms were used for the goal of end of disease epidemic; for example, eliminate disease epidemics was used for yellow fever and meningitis A. 42,61

Interventions and process targets
We broadly categorized interventions into five groups: prevention, early detection, clinical management, surveillance and other, and presented the quantitative process targets (online repository). 69

Assessment processes
Certification was the main assessment process for the goal of worldwide permanent reduction to zero, while verification was the main process for the goals of interruption of transmission and endemic transmission.Validation was the main process for the goals of elimination as a public health problem or threat, and elimination of vertical transmission.One infectious condition (Chagas disease) with a goal of elimination as a public health problem had verification as an assessment process, because the elimination strategy involves interruption of transmission through four of six transmission routes, while disease control is the goal for the remaining two routes.We did not identify any assessment processes for the goals of pre-elimination, end of disease epidemic and disease control.

Discussion
This systematic review investigated elimination and eradication goals for infectious conditions, and their associated definitions, terminology, targets and assessment processes.We identified nine different goals, ranging from disease control to eradication across 27 infectious conditions.These goals were not mutually exclusive for these conditions and 11 conditions had more than one goal.Goals had been met for only two conditions.This review highlights the progression of goals along a disease-control continuum, such as end of disease epidemic to preelimination to elimination as a public

Author
Year published Disease focus WHO Regional Office for South-East Asia 51

2020
Measles, rubella and congenital rubella syndrome WHO Regional Office for Europe 52 2020 Tuberculosis WHO 53 2021 Trachoma WHO Regional Office for South-East Asia 54

2021
Cervical cancer WHO Regional Office for South-East Asia 55 2021 Leprosy WHO Regional Office for South-East Asia 56 2021 Leprosy WHO 57 2021 Lymphatic filariasis WHO 58 2021 Malaria WHO Regional Office for the Eastern Mediterranean 59

Global
Varies and not yet reached, we have put not applicable; however, some individual countries could have met these targets ahead of their timeline. Infectious conditions with more than one goal.d European, 2015; Americas, 2023; Western Pacific, 2020; and South-East Asia, 2023.An update on the status of the 2015 and 2020 targets (achieved or not) was not provided in the documents reviewed.e In case of elimination of leprosy as a public health problem: the target has been met by all countries, except Brazil; although no formal validation process was developed as the target indicator could be determined through a straightforward mathematical calculation.f 12 of 59 priority countries are yet to achieve the goal, while 47 have been validated as having met the goal.g Although the goal for Chagas disease is elimination as a public health problem, this goal is achieved by interruption of transmission through four out of six transmission routes -vector, blood transfusion, organ transplantation and congenital; the other two routes are food and laboratory accidents.Therefore, the assessment process is verification of interruption of transmission through these four routes, and not validation.h By 2020, 0/41 countries had achieved the goal of elimination of vertical transmission of Chagas disease.An update on the status of the disease control target via oral transmission (achieved or not) was not provided in the documents reviewed.i For meningitis, the goal is to eliminate vaccine-preventable bacterial meningitis epidemics as a public health threat.j Primarily bacterial STIs, gonorrhoea (bacterial), syphilis (bacterial) and chlamydia (bacterial).However, one overall target also includes trichomoniasis (parasitic).For STIs, the goal is to end the STI epidemic as a public health concern.k The goal is to end the AIDS/HIV epidemic as a public health threat.l The goal is to eliminate yellow fever epidemics.

Pre-elimination
Tuberculosis (low-incidence countries) 27 health problem or threat.A clear understanding of where the specific infectious disease goals fall on this continuum of disease control is important to avoid misperceptions and miscommunication of overall objectives.As we approach the 2030 target date to achieve many of these goals, and for other infections to become candidates for elimination in the future, clarity of definitions and objectives is important for public health professionals and policy-makers.We found that a range of terms have been used to classify infectious condi-tions, including a public health concern, problem and threat.1][72] The use of non-standardized terminology that we identified makes it unclear how and when a condition is deemed a public health threat or a concern based on these three criteria.We therefore propose standardized definitions for the terms public health threat and public health concern (Box 2).For meningitis A and yellow fever, the term eliminate disease epidemics was used, 42,61 which may cause confusion as to whether the goal is to end the disease epidemic or eliminate the disease as a public health problem or threat.We recommend that WHO considers standardizing terminology across all infectious conditions targeted for elimination or eradication.
Noteworthy is that for the goal of end of disease epidemic, with relative reduction global targets, a so-called one-size-fits-all approach is not appropriate, as these targets could mean different things to different countries depending upon their endemicity and starting point.WHO encourages countries to adapt strategic directions and goals to local epidemiological and health system contexts. 64Some countries therefore have locally adapted targets for infectious conditions, such as HIV/ AIDS.However, discrepancies may exist between the selected goal and its targets.For example, England has a goal of "ending HIV transmission" or

Disease control
Chagas disease (oral route) 16 NR NA NR NR NR Cutaneous leishmaniasis 22 No impact targets for disease endpoint NA NR NR NR Schistosomiasis 26 Prevalence 1 < 5% heavy-intensity infections f NR NR AIDS: acquired immunodeficiency syndrome; HBsAG: hepatitis B surface antigen; HIV: human immunodeficiency virus; NA: not applicable; NR: not reported; STIs: sexually transmitted infections; TF: trachomatous inflammation -follicular; TT: trachomatous trichiasis.a The target is for 20 endemic countries to eliminate cholera.b Based on four of six transmission routes, that is, vectoral, transfusion, transplantation and congenital.The other two transmission routes are oral and laboratory accidents.c In areas where Wuchereria bancrofti is endemic and Anopheles or Culex is the main vector.d In areas where Aedes is the main vector.e In areas where Brugia spp. is endemic.f Heavy intensity of infections: Schistosoma mansoni (400 eggs/g faeces, S. haematobium (50 eggs/10 mL urine).g Caused by Ascaris lumbricoides, Trichuris trichiura, Necator americanus and Ancylostoma duodenale.h For details on the impact targets for the European region, see online repository. 69 Additional target for countries using targeted timely hepatitis B vaccine birth dose.j Breastfeeding countries: countries where the benefits of breastfeeding in terms of child survival outweigh the risk of HIV transmission via breastfeeding.Nonbreastfeeding countries: countries where women living with HIV who give birth are strongly recommended to avoid breastfeeding due to evidence of a risk of HIV transmission via breastfeeding.k Childhood prevalence is a proxy for incidence of chronic hepatitis B virus infection.l For viral hepatitis, the relative reduction targets are from a 2015 baseline; while the absolute targets take the baseline of 2020, however, the relative reduction targets from a 2020 baseline can be calculated from document ref# 64; likewise, for TB, the relative reduction targets are from a 2015 baseline.m From a 2020 baseline.n Mortality associated with causes related to tuberculosis, hepatitis B and C. o The targets can be adapted nationally depending on the baseline point.Note: For shared targets with HIV, viral hepatitis and STIs, see online repository.69 (. ..continued)

Public health concern
A public health concern is an infectious condition that affects a significant proportion of a specific population and fulfils the following criteria: (i) likely increasing in trend or has a potential for outbreaks and/or community spread; (ii) high burden in terms of morbidity and quality of life; (iii) low overall risk of death; (iv) perceived as low-to-moderate risk by the general public; and (v) feasible to act on the condition at a community level.

Public health threat
A public health threat is an infectious condition or problem that potentially affects a significant proportion of a specific population and fulfils the following criteria: (i) likely increasing in trend or has a potential for outbreaks and/or community spread; (ii) high burden in terms of morbidity and/or mortality and quality of life; (iii) high overall risk of death; (iv) perceived as high risk by the general public; and (v) feasible to act on the condition at a community level.
Infectious diseases control goals Laila Khawar et al.
"to eradicate HIV transmission" 10,11 with a target of < 100 new cases a year by 2030. 73Australia has a goal of "ending HIV transmission" or "virtual elimination of HIV transmission, " with a target of 90% reduction in HIV infections by 2025 compared with 2010. 9Ending transmission of HIV is not the same as ending the HIV epidemic; the former implies interrupting transmission (zero cases), which is a misnomer if the target threshold is greater than zero.Likewise, we found that WHO only used the term virtual elimination for elimination of vertical transmission of HIV as a public health problem.Importantly, this term cannot be used interchangeably with ending or interrupting transmission.Clarity about these definitions is crucial so that important programmes are not prematurely de-funded.We recommend that countries aiming for a measurable elimination target that has a threshold of greater than zero cases consider aligning a more suitable goal to this threshold, such as elimination of HIV as a public health problem or threat.We also urge the scientific and health policy communities not to use the term eradication for a limited geographical location, as this term is reserved for worldwide interruption of transmission, where intervention measures are no longer needed anywhere.
Our review highlighted a chronological arrangement of tuberculosis goals, which provides a broad understanding of progression of goals where ending a disease epidemic and preelimination are a stepping-stone towards a higher goal of elimination as a public health problem.The goal of elimination as a public health threat was also identified as equivalent to the goal of elimination as a public health problem. 63n Fig. 3, we offer a graphical representation of the core concepts of disease control, elimination and eradication, with distinct goals along the spectrum of these concepts.We recommend a clear distinction be made between terms such as interruption of transmission, which is used once transmission is stopped, versus elimination of transmission, which is reserved for when the goal of interruption of transmission has been maintained years after achieving it.This distinction was clearly highlighted in one of the documents on onchocerciasis. 32Fig. 3 gives an overarching depiction of the disease control continuum and may not be applicable in its entirety to all infectious conditions.For some infectious conditions, which are not suitable for elimination or eradication, the end goal may just be an advanced level of control, for example, meningitis A or yellow fever.In addition, for some infectious conditions, interruption of transmission could be part of the overall strategy of elimination as a public health problem.For example, for Chagas disease, the aim is to interrupt transmission via four of six transmission routes to attain the overall goal of elimination as a public health problem. 22mportantly, the goal of elimination as a public health problem or threat needs to be reinforced, and probably rephrased, as an advanced level of control.This goal was created to secure the political impetus necessary for any concerted public health initiative. 74Achievement of this goal could create a false sense of success, and resource-constrained countries may divert their funds to other emerging problems, which could lead to continued undetected transmission resulting in undiagnosed cases and underreporting.One such example is leprosy, where evidence suggests that only 50% of cases are currently being detected in certain countries that have  had otherwise met this goal. 75Further research is required to study the inadvertent consequences and costs of elimination and eradication, including the environmental impact of eliminating a vector.We collected information on all interventions across the diseases, but to present our results concisely, we reduced interventions to five broad categories and included the respective interventions as footnotes in the online repository. 69For some conditions, such as, measles, rubella and congenital rubella syndrome, and meningitis A, we could not include all process targets, mostly related to laboratory testing and surveillance.Nonetheless, we included the essential process targets for these conditions.We excluded documents on diseases targeted only for disease control, such as Buruli ulcer and scabies, as the goal is in line with the definition of disease control defined at the Dahlem Workshop and does not require further clarification.Likewise, we excluded documents on coronavirus disease 2019 (COVID-19) as WHO has not targeted this disease for elimination.However, noteworthy is that WHO recently shifted its strategic objectives for COVID-19 from an emergency to a longer-term disease prevention and control response. 76e conducted our review in line with PRISMA guidelines and used a robust search strategy, covering a study period of more than 15 years.This method increases the validity of the results and allowed us to provide a comprehensive systematic review on disease control initiatives.
de eliminación en el futuro, es crucial mantener la claridad en las definiciones y en los objetivos para que los profesionales públicos sanitarios y las personas encargadas de la elaboración de políticas no hagan uso de ideas erróneas y no haya problemas de comunicación.

Fig. 3 .
Fig. 3. Graphical representation of disease control goals and their assessment processes

Flow diagram of selection of documents on disease eradication
Continued actions are required to prevent re-establishment.Example: measles Eradication Permanent reduction to zero of the worldwide incidence of infection caused by a specific pathogen as a result of deliberate efforts; intervention measures are no longer needed.Example: smallpox

by infection type and infectious condition Scope Target date Year achieved a Assessment process and geographi- cal level of award
(continues. ..)Bull World Health Organ 2023;101:649-665| doi: http://dx.doi.org/10.2471/BLT.23.289676Infectious diseases control goals Laila Khawar et al.Goal type, AIDS: acquired immunodeficiency syndrome; HIV: human immunodeficiency virus; NA: not applicable; STIs: sexually transmitted infections; WHO: World Health Organization.a Where the target date is 2030